Doorstop - Dr Bill Glasson, AMA President, Parliament House, Canberra - Medical indemnity

GLASSON: I just want to bring to your attention - we've had a premium come out of South Australia in the last 24 hours for obstetricians, who are basically from New South Wales, they will be charged $140,000. I repeat, $140,000.

Now, we have talked about - we've talked about this issue of medical indemnity now for some time and we have essentially, I suppose, put some of the planks in place. And I give the analogy, a bit like the Titanic. The State Governments have plugged some of the holes and the Prime Minister, through his various schemes, has plugged other holes. But essentially the ship is taking on water and what lies ahead, I'm afraid, is a large iceberg, which we call workforce, or lack of it.

And I can tell you that if you send out $140,000 premiums to our obstetricians, or any other doctors around this country, there will not be any workforce.

We have come from a situation where we have lived and we've taken for granted one of the best medical systems in the world and we're about to let it go down the drain or down the sink or into the depths of the ocean, whatever you like to say.

Unless this is addressed, and we keep saying that essentially this is not a government problem, this is not a lawyers' problem, this is not a medical problem, this is a society problem. And my really clear, message to the governments out there and to the community out there is listen. For goodness sake, let's get this issue addressed. Otherwise, we will not have a medical workforce.

The complaints the backbenchers are getting is not about the issue that there's no bulk billing. The issue is about there's no doctors. And there will be fewer doctors.

Now, it's been clearly indicated by the College of Surgeons they're going to lose 15% of their workforce unless this issue is addressed, really, before the end of this month. And so the implications on the workforce are extraordinary.

So what should we do is the question. I would suggest to you that this method or the model that we're working with at the moment is not working. That it is essentially based on a fault based adversarial system. That you as patients out there have to prove some form of negligence to get compensation.

That is expensive and essentially it is not sustainable. We have to move to another system which I feel needs to be based essentially on a no fault system, whereby you as a patient are able to get appropriate recompense without having to prove negligence.

I say if you lose your leg, I don't care whether you lose your leg because the doctor kept the tourniquet on too long, or you lost it in a car accident or you lost it because you fell out of a tree. You've lost your leg and, as such, you need compensation so that you can manage and function as normally as possible in society.

So I suppose that clear message is that what we have predicted is happening. By the time the tort law reforms kick into place and by the time the federal legislation kicks into place, you won't have a workforce to actually call upon.

QUESTION: Can you just clarify ... you're talking about a New South Wales based obstetrician who has received a premium bill for next year for $140,000?

GLASSON: Yes. What they are is the New South Wales Obstetricians who went to another MDO* outside of New South Wales. In other words, they left UMP when UMP looked as though it was about to hit the wall. And now they have - all the New South Wales obstetricians, who have insured with this particular company - received premium notices for $140,000.

QUESTION: Now, won't a significant part of that actually already be paid by taxpayers? Because the Federal Government have said they will pay half of the difference, won't they, between the next closest specialty?

GLASSON: A good point. A good point. That is correct. So essentially...

QUESTION: What will they actually be paying?

GLASSON: Essentially they will pay - the government will pay 50% of the amount above the equivalent of what a gynaecologist would pay. So essentially they would probably be paying in the order of around about $100,000. I'd suggest the government - the taxpayer I might remind you, the taxpayer yet again will be paying the $40,000.

So it suggests there's a problem in the system when we as a taxpayer have to then subsidise the whole mechanism to try and keep some sort of sustainable workforce.

QUESTION: Kay Patterson has championed the Federal Government's response to medical indemnity as one of the success stories of her time in the portfolio. Would you agree with that assessment?

GLASSON: Look, the government - and I compliment John Howard and the government for trying to address this issue in a constructive way, but essentially they're working with the wrong system. The system is wrong and what they're trying to do is patch up a system that is basically unpatchable.

We've got to get - as I say, we've got to move away from a system where we've got to prove fault. And we've got to judge people on the fact they have a disability, for whatever reason, and hence they need compensation. So I do feel that the current system we're working on is not sustainable in the long term. They have tried, I admit that. The government has tried. They've recognised the problem but I think we're going to follow the American history in essentially what happens is we repeat this cycle every five years, and so it's the wrong system.

QUESTION: You're talking about overturning hundreds of years of legal practise and it's a big job?

GLASSON: It is a big job, but I think unless we address it ... as I say, I'd like to sit on my rocking chair and think that I've got the best doctors, you know, that can look after me. At the moment all that I'm looking at is a pretty big black hole, because I don't think we're going to have the doctors out there that can provide that service.

Can you imagine a young medical student sitting back thinking, 'Geez, I'd love to be an obstetrician. By the way, I need $140,000 up front before I can actually deliver my first baby.' By the way, you've got to pay that money and then retrieve the amount back from the government afterwards. So you've still got to put that money up front.

This is not going to attract people into the profession and obviously the 'o' part of obstetrics and gynaecology will disappear. It will be a dinosaur. So you'll just have gynaecologists, so hopefully, you won't have to have any babies.

QUESTION: What's going to happen after July 1, in your view?

GLASSON: Well, see what's happened. After July 1, a lot of people will have had what they call claims incurred policy. In other words, that you had a full cover for incidents not only that you knew about but incidents you didn't know about. After 1^st July everybody will be on this claims made policy, where essentially you've got this issue in relation to claims that you don't know about - what we call a tail, or an unfunded tail.

And so a lot of doctors will make a decision that, listen, I'm not willing to continue to operate in this system where basically there's so much uncertainty in the system and also what we're seeing going to happen, and I keep saying doctors don't pay for this. You know, people say doctors have got big pockets. I'm afraid the doctors have got hands in your pocket because that's where they get the money from. So you as the consumer will have to pay for this. And essentially you cannot afford to pay.

If you're talking about obstetrics, this is going to be something like $1500 to $2,000 every delivery you're going to have to pay out of your pocket on top of what you pay the doctor and the hospital.

So that's not sustainable. So what will happen? You'll all have to go up and have your babies delivered publicly. The public system is in a huge crisis situation anyway, and so this will put further pressure on a system that's failing.

QUESTION: This no fault system that you're talking about, who do you see it being administered by? And how do you see it being funded?

GLASSON: Well, essentially - when you talk about funding, funding can either occur at the point of service, in other words, at the moment you see the doctor. It can be funded by the taxpayer through the system. Or it can be funded by the taxpayer at the top end. In other words, in the no fault scheme I would suggest to you that basically it'll have to be funded in part by doctors or patients directly, and in part by taxpayers' funds.

QUESTION: Would it see the removal of insurance companies?

GLASSON: Not necessarily. I think they can still be used as far as the mechanism of delivering this service and providing the service. But I think what we need to do is to sit down with a big think tank and decide how we can actually make this work.

And all the time think about patients. Think about you as a patient. What is the most applicable way that we can provide this service to you so that you can both access the services and make them affordable.

QUESTION: Under a no fault scheme, would patients lose the right to sue doctors?

GLASSON: No, I mean, if you look at the New Zealand scheme, I mean there's two elements to an adverse outcome. There is an element that relates to negligence, but the major element relates to your disability or your incapacity. And so what we're saying is that why don't we measure that disability and have you compensated accordingly? And if I have been truly negligent and I've done something incorrect, then essentially there may be other due processes, legal processes through which justice may be sought. But essentially you as a patient should not have to go through a complex adversarial system where you've got to prove fault to actually get compensation if it's for you or your child when we're talking about obstetric cases.

QUESTION: So if patients retain the right to sue doctors for negligence in those cases where there is negligence, why then would premiums come down? Wouldn't there still be huge premium issues...

GLASSON: Well, the biggest thing driving demand for these, you know, for legal services, for this whole issue is that anybody who has an adverse outcome in medicine and has a disability, the only way they can actually get some sort of compensation is to prove negligence.

What we are saying is that is wrong. And at the end of the day, if I have a disability for whatever reason I feel that I should - like from a motor vehicle accident, for instance - I can get appropriate compensation. In most cases patients don't go out there to prove negligence. Their prime aim is to try and get some financial compensation for the incapacity they have. And I think you'll find that there'll be less emphasis on trying to prove doctors wrong rather than actually prove that they have got a disability that needs to be compensated.

QUESTION: But your proposal would end up seeing more money paid out. You'd be paying patients who had suffered from doctors negligence and you'd be paying those who haven't?

GLASSON: No. I think, at the end of the day, the cost involved with defending claims on a day to day basis is probably the biggest - particularly the smaller claims - is one of the biggest cost drivers in the system. I think if you have it streamlined, you have it properly set up like the workers compensation or traffic accident type schemes, and you know that if you lose your leg in a traffic accident you'll get 'x' amount of dollars. And so it's very well documented and quantitated. And essentially that will remove a lot of those expenses in relation to actually handling claims and trying to defend claims. Because that's where a lot of the expenses are in these systems, particularly for the claims that are less than $100,000.

QUESTION: What about medical indemnity lawyers? Won't they lose their livelihood?

GLASSON: Oh, no, I don't think so. Lawyers are pretty smart people. I'm sure they can find other avenues to go into and, from the point of view of indemnity, suing doctors. I mean, as part of this whole equation, we're firmly behind supporting the college just to make sure there's appropriate reaccreditation of doctors. That each of us undergo appropriate upskilling to make sure that our standards are the best. And, by the way, they are the best in the world. We have got one of the safest medical systems in the world. My concern is that we're actually destroying it on the pretext of actually trying to get some compensation for people who have adverse outcomes for whatever reason.

QUESTION: Just finally, this government have continually rejected what you're talking about all the way through this indemnity process. What's the point of you arguing this when they've shown no indication of...

GLASSON: Well, we've made it very clear to the government we're happy to continue, you know, to evolve with the process. And we will continue with the process. But, at the end of the day, I think the process will develop with what we've done. We keep saying what we have is an eye fillet price for a chuck steak product. In other words, what we've dealt with is a product that is second rate and is unaffordable.

And so I think that we need to recognise that and essentially move to a new system. Because the current system I do not believe is sustainable. I do not feel it's fixable. I think all parties that have tried and they will continue to try. But I think, at the end of the day, the affordability issue will drive us out of business as such, and that we will not have a workforce to call upon.

QUESTION: Is obstetrics the only area where there's this crisis? Or is it in other specialties as well?

GLASSON: No. I mean obviously obstetrics and neurosurgery are the two key areas we talk about. But it really extends across to - you know, people - the groups that are not being subsidised, particularly in areas like orthopaedics. To some degree the anaesthetic people who work with obstetricians, those people who are not actually receiving subsidies at the moment in their premiums, they are the people that really are finding it difficult and they're struggling.

And so we've got to look at the profession across the board. And at the moment we are in a situation that we are, you know, we are really jeopardising the future of high quality medical care in this country. And I just think that enough is enough. My doctors are saying enough is enough. We can't continue to, I suppose, operate in this environment of uncertainty in relation to our future, and in a future where you as a doctor every time something goes wrong and the feeling is, 'God, somebody else is going to sue me, you know.'

Rather than, I mean doctors are out there trying to do the best by their patients. No one intentionally hurts anybody, and therefore we need to have a system, as I say, that really reflects the true values of what patients need to make sure that just - that patients get the justice they need. But, in doing that, make sure that we sustain the high quality medicine in this country that we're used to.

QUESTION: Just on bulk billing, the latest quarterly stats broken down by electorate are out today. They show that there's an increasingly rapid decline in bulk billing in regional Victoria and New South Wales. There was a 9% drop over the first three months of the year in Ballarat. What does that say to you?

GLASSON: It says to me that the Medicare rebate fails to reflect the cost of running high-quality medical practice. Doctors are out there trying to provide a service to their patients. And for the last decade or more they have attempted to do the right thing and charge the Medicare rebate or bulk billing rate. They have finally decided, for issues such as the rate of indemnity insurance, that the costs of running high quality practice mean they cannot sustain high quality medicine with the current Medicare rebate.

And so I think you'll see more and more doctors drop out of it because they feel, not necessarily for all patients but for a percentage of their patients, because they just can't provide the quality. And so until the Medicare rebate - and this is our insurance when we go and see doctors, that's what we call upon - until it truly reflects the value of what it costs to run a high quality general practice or specialist practice, those gaps will increase.

Now, my concern is for those mothers out there with two and three kids paying a house off, paying a car off, or mums and dads with chronic disease that have to go to their doctors on a regular basis, those gaps will become unaffordable. And essentially, again, it will drive them back into the public system. Into a system that is, as I keep saying, is underfunded and basically under a huge amount of pressure. Okay.

Ends